Cheney Transplant Turns Focus to Age and HF Treatments

Already battered by a handful of MIs, former Vice President Dick Cheney's heart required help that arrived in the form of a left ventricular assist device (LVAD) in 2010. More than 20 months later -- on Saturday -- the wait ended when he received a new heart at Inova Fairfax Hospital in Falls Church, Va.

Clinicians contacted by ABC News and MedPage Today largely agreed that his receipt of an LVAD -- the HeartMate II -- enhanced the public's awareness of that treatment option, and his 20-month survival, combined with Saturday's transplant is likely to spark renewed enthusiasm for interventions aimed at extending the lives of patients with advanced heart failure.

"Cheney's situation demonstrates that we can provide really great care for patients with advanced heart disease and it no longer needs to be considered a desperate situation," according to Clyde Yancy, chief of cardiology at Northwestern University in Chicago and a past president of the American Heart Association.

The "Face" of LVAD

When Cheney received the mechanical assist device it lifted the veil on the technology and facilitated discussion about the device with patients with heart failure, said Mary Norine Walsh, MD, Medical Director of the Cardiac Transplant Patient Program at St. Vincent Heart Center in Indianapolis and spokesperson for the American College of Cardiology.

His situation, she told MedPage Today, "changed people's perception of the therapy."

And, Walsh said, Cheney's ability to not only survive using an LVAD but to transition from being very ill to being an appropriate candidate for transplantation will further underscore the success of the device. The HeartMate II has been approved both as a bridge to transplant and as long-term or destination therapy in patients who are not candidates for transplantation.

Walsh said that Cheney's high profile, his willingness to talk about his LVAD, and his active lifestyle since implantation -- book tours, TV appearances -- increased public awareness of LVADs, and that she often mentions the former vice president when speaking with patients about treatment options.

Now, Yancy said, Cheney's heart transplantation provides another opportunity to make people aware of the existence of effective treatments for heart failure, including implantable cardioverter-defibrillators, medical therapies, revascularization procedures, LVADs, and transplant.

Cheney's demonstrates, Yancy said, that the time has come to consider LVADs as part of the treatment strategy.

Not Without Risk

At least one clinician, however, does not think that the publicity surrounding Cheney's condition will have an effect on the use of LVADs in the near future.

"Fortunately, he had a successful bridge to transplant, but the devices are not without risk, such as bleeding, infection, and stroke," wrote Patrick McCarthy, MD, chief of cardiac surgery at Northwestern University, in an email to ABC News and MedPage Today.

In addition, Timothy Gardner, MD, medical director of the Center for Heart & Vascular Health at the Christiana Care Health System in Newark, Del., and a past president of the AHA, noted that there can be some complications from long-term LVAD use, including GI tract bleeding.

"Therefore, heart failure cardiologists and surgeons reserve their use to patients who are at risk for not surviving to transplant, or who are not candidates for transplant, so that the benefits outweigh the risk," McCarthy wrote. "Trials are ongoing using the device in less sick patients as the risks of LVAD use today are much lower than in the past."

Too Old?

There has been some discussion about Cheney's suitability for a cardiac transplant because of his age, 71, which is near the upper range at which most patients undergo heart transplantation.

Although older patients -- beyond age 60 or 65 -- typically undergo a more rigorous evaluation of their eligibility for transplantation, the final decision to put a patient on the waiting list is more based on an assessment of his or her health and the absence of other significant life-limiting disease, according to Yancy.

When heart transplants first started being performed, they were originally reserved for younger patients, but changes in surgical expertise and immunosuppressive therapy have expanded the pool of eligible patients.

Walsh said the reason it is somewhat unusual for patients older than 70 to receive a new heart is that people do not usually reach that age without other major comorbidities. The over-70s are a small but growing segment of the heart transplant population, she added.

Age is not a major consideration when looking at Cheney's outlook either, Walsh said.

Although he will have to be vigilant for signs of rejection and infection, especially during the first year, the fact that Cheney's doctors considered him a good enough candidate for transplantation indicates that his chances of doing well for the next several years are excellent, she said.

Yancy noted that Cheney's case can be used to help change the perception of heart failure as a generic disease of aging to one that is not a lost cause.

"There are some opportunities here to put a light on treating advanced heart failure, to put a light on LVADs, and to highlight that heart failure is a big deal," Yancy said. "It's a growing concern and we are making great strides in treating it. We shouldn't just dismiss it as a phenomenon of aging and let it go. We can do something about it."

Both Yancy and Walsh said that they hope the case also will draw attention to the need for donor organs.

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